Dangerous liaisons

Heidi Larson | 19 Nov, 2016

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Donald Trump could be the biggest single threat to vaccine confidence ever faced.

Trump’s links to the likes of Andrew Wakefield – with his network of celebrity supporters as well as multiple parent associations – is particularly worrying. Furthermore, although clearly not loved by all, both Trump and Wakefield have their champions well beyond the US and UK. An alliance between the world’s most widely known – and self-promoting – vaccine critic and the elected figure to one of most powerful political positions in the world is, to say the least, a dangerous liaison.

Anti-vaccination lobbyists are already seeing Trump as an ally. Shortly after the election results were known, the ‘The Age of Autism’ posted: ‘Now that Trump won, we can all feel safe in sharing that Mr Trump met with autism advocates in August. He gave us 45 minutes and was extremely educated on our issues.… Dr Gary ended the meeting by saying “Donald, you are the only one who can fix this”. He said ” I will”. We left hopeful. Lots of work left to do.’

Rightly or wrongly Trump is seen as ‘a man who can make things happen’, a challenger of orthodox thinking, and a beacon of hope to those who believe that any alternative is worth trying to break the status quo.

Trump’s widely followed tweets and public statements about children becoming autistic after vaccination, and calling for the end of combination vaccines because ‘tiny children are not horses,’ are a small indicator of Trump’s views on vaccines which are being propagated, unchecked by political or policy processes.

Trump’s views on science, climate change, abortion rights and the future of healthcare in general are all cause for concern, but a viral spread of negative sentiment around vaccines can tip confidence like swings in the stock market and, for the more infectious diseases, have immediate debilitating consequences.

The confidence levels required to maintain vaccination at a sufficient level to ensure herd immunity are high. Currently 83% of Americans think that vaccines are safe – but, only a small drop in that number could lower vaccine confidence and uptake to unacceptable levels and risk disease outbreaks. In Texas, Wakefield’s current home state, the trend in vaccine exemptions is already accelerating with the number of exemptions up to 44,716 in 2016, from only 2,314 in 2003.

And so there is also ‘lots of work’ for the public health community to do, as well as parents and others who value vaccines. Faced with the Trump challenge we must make sure that our science is robust, transparent and accessible to all. We must further ensure that communication around vaccines avoids patronising ‘expert’ tones, and instead builds confidence from a human, personal perspective. It was empathy with the public that has launched both Wakefield and Trump to their revered leader status in their respective, as well as overlapping, circles.

It is apt that this week Oxford Dictionaries announced that the 2016 ‘Word of the Year’ is “post-truth” which they define as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.”

In a world of upsets, surprises, a desire for any alternative to the status quo and an emergence of ‘blind faith’ triumphing over science, we cannot be over-prepared in our readiness to meet the questioning and debate that lies ahead.